Applicant's Last Name
Applicant's First Name
Case Verification Number
Part 1. Information From the Registered Agency
Part 2. USCIS Responses
(continued)
NOTE: Only USCIS should complete this information.
Registered Agency Information
Upon review of these documents, information submitted, and
our records, we find the following for the applicant:
10.
Registered Agency Case Number
1.
Lawful Permanent Resident of the United States
Conditional Permanent Resident of the United
2.
States
Full Name of Agency Official
3.
Applicant is employment authorized in the United
11.a. Last Name
States as indicated:
No Expiration Date (Indefinite)
11.b. First Name
Expiration Date
12.
Title of Agency Official
(mm/dd/yyyy)
Previous Employment Authorization Dates
13.a. Daytime Telephone Number (Include Area Code)
Start Date (mm/dd/yyyy) End Date (mm/dd/yyyy)
13.b. Extension Number (if applicable)
14.
Fax Number (if any) (Include Area Code)
4.
Applicant is not employment authorized in the
15.
Date Request Completed
United States
(mm/dd/yyyy)
5.
Applicant has an application pending for the
following USCIS benefit:
16.
Registered Agency Comments (if any)
6.
Applicant was granted asylum or refugee status in
the United States
7.
Applicant was paroled into the United States under
section 212 of the Immigration and Nationality Act
(INA).
No Expiration Date (Indefinite)
Parole Granted Date
(mm/dd/yyyy)
Parole Expiration Date
(mm/dd/yyyy)
8.
Conditional entrant of the United States
9.
Nonimmigrant (Specify type or class and expiration
date)
Type or Class
Expiration Date (mm/dd/yyyy)
10.
U.S. Citizen
Form G-845 05/20/15 N
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